I really used to laugh at those folks are you still laugh at those folks you
are you still laugh at those folks you
are you still laugh at those folks you know the type I mean to use gadgets like
know the type I mean to use gadgets like
know the type I mean to use gadgets like this with ings and fitbit’s measuring
this with ings and fitbit’s measuring
this with ings and fitbit’s measuring everything that went in and out of their
everything that went in and out of their
everything that went in and out of their bodies in 2011 this field was called
bodies in 2011 this field was called
bodies in 2011 this field was called quantified self it really took off and I
quantified self it really took off and I
quantified self it really took off and I used to really laugh at these folks
used to really laugh at these folks
used to really laugh at these folks until 2012 when I stepped on a scale and
until 2012 when I stepped on a scale and
until 2012 when I stepped on a scale and I weighed 247 pounds I thought to myself
I weighed 247 pounds I thought to myself
I weighed 247 pounds I thought to myself when I hit 250 they can measure me in
when I hit 250 they can measure me in
when I hit 250 they can measure me in tons that’s an eighth of a ton this is
tons that’s an eighth of a ton this is
tons that’s an eighth of a ton this is literally what I look like
literally what I look like
literally what I look like during my 2012 TEDMED talk some people
during my 2012 TEDMED talk some people
during my 2012 TEDMED talk some people are embarrassed to see their videos I
are embarrassed to see their videos I
are embarrassed to see their videos I was really embarrassed to see this video
was really embarrassed to see this video
was really embarrassed to see this video I thought to myself what happened to me
I thought to myself what happened to me
I thought to myself what happened to me I’m driving everywhere in Silicon Valley
I’m driving everywhere in Silicon Valley
I’m driving everywhere in Silicon Valley I used to walk a lot I bought everything
I used to walk a lot I bought everything
I used to walk a lot I bought everything Fitbit bakes I started tracking my steps
Fitbit bakes I started tracking my steps
Fitbit bakes I started tracking my steps like many of you do now but actually
like many of you do now but actually
like many of you do now but actually more interesting I start to weigh myself
more interesting I start to weigh myself
more interesting I start to weigh myself every day and I record everything I eat
every day and I record everything I eat
every day and I record everything I eat I’ve recorded every meal every day for
I’ve recorded every meal every day for
I’ve recorded every meal every day for the past five years I lost 50 pounds and
the past five years I lost 50 pounds and
the past five years I lost 50 pounds and two and a half years
this is a day the driven weight-loss and
this is a day the driven weight-loss and me as a data scientist this was an
me as a data scientist this was an
me as a data scientist this was an incredible experience I learned a lot I
incredible experience I learned a lot I
incredible experience I learned a lot I learned that it doesn’t really matter
learned that it doesn’t really matter
learned that it doesn’t really matter about the quality of the food entries
about the quality of the food entries
about the quality of the food entries you make I know the good days I know the
you make I know the good days I know the
you make I know the good days I know the bad days but in a precision way I now
bad days but in a precision way I now
bad days but in a precision way I now know which are the foods that add excess
know which are the foods that add excess
know which are the foods that add excess calories to my waistline it doesn’t
calories to my waistline it doesn’t
calories to my waistline it doesn’t matter if the data is inaccurate the
matter if the data is inaccurate the
matter if the data is inaccurate the learning is precise now I’m not giving a
learning is precise now I’m not giving a
learning is precise now I’m not giving a product testimonial for Fitbit not
product testimonial for Fitbit not
product testimonial for Fitbit not everyone gets the same results I’m an
everyone gets the same results I’m an
everyone gets the same results I’m an early adopter for a lot of these gadgets
early adopter for a lot of these gadgets
early adopter for a lot of these gadgets I love the social aspects all of my
I love the social aspects all of my
I love the social aspects all of my friends on Fitbit on Facebook know with
friends on Fitbit on Facebook know with
friends on Fitbit on Facebook know with my Fitbit I lost 50 pounds but here’s
my Fitbit I lost 50 pounds but here’s
my Fitbit I lost 50 pounds but here’s the interesting point I made the most
the interesting point I made the most
the interesting point I made the most major health intervention of my life but
major health intervention of my life but
major health intervention of my life but I when I went to go see my primary care
I when I went to go see my primary care
I when I went to go see my primary care doctor at a major medical system near
doctor at a major medical system near
doctor at a major medical system near here and they spent a billion dollars
here and they spent a billion dollars
here and they spent a billion dollars installing an electronic health record
installing an electronic health record
installing an electronic health record system my primary care doctor was the
system my primary care doctor was the
system my primary care doctor was the last one to know I lost 50 pounds
last one to know I lost 50 pounds
last one to know I lost 50 pounds because their billion-dollar system
because their billion-dollar system
because their billion-dollar system doesn’t talk to my $40 gadget and that
doesn’t talk to my $40 gadget and that
doesn’t talk to my $40 gadget and that has to change we have to make that
has to change we have to make that
has to change we have to make that change and like that medicine is gonna
change and like that medicine is gonna
change and like that medicine is gonna change from this bygone era of hands-on
change from this bygone era of hands-on
change from this bygone era of hands-on practice into a new era of data-driven
practice into a new era of data-driven
practice into a new era of data-driven medicine now data and computation have
medicine now data and computation have
medicine now data and computation have changed many fields over the past few
changed many fields over the past few
changed many fields over the past few decades it was only a matter of time
decades it was only a matter of time
decades it was only a matter of time before this happened to medicine and
before this happened to medicine and
before this happened to medicine and data by itself doesn’t do anything I as
data by itself doesn’t do anything I as
data by itself doesn’t do anything I as a patient I want to share my data now
a patient I want to share my data now
a patient I want to share my data now with those that care about me and those
with those that care about me and those
with those that care about me and those that care for me but this is a
that care for me but this is a
that care for me but this is a partnership now the physician of the
partnership now the physician of the
partnership now the physician of the present or the physician of the future
present or the physician of the future
present or the physician of the future needs to accept that data and send back
needs to accept that data and send back
needs to accept that data and send back advice and recommendations that doesn’t
advice and recommendations that doesn’t
advice and recommendations that doesn’t happen today so let’s not lament the
happen today so let’s not lament the
happen today so let’s not lament the fact that data is driving medicine in
fact that data is driving medicine in
fact that data is driving medicine in the future let’s celebrate it and let’s
the future let’s celebrate it and let’s
the future let’s celebrate it and let’s use it
use it
use it and let’s get more patients and
and let’s get more patients and
and let’s get more patients and healthcare providers using the data
healthcare providers using the data
healthcare providers using the data that’s out there we have so much data in
that’s out there we have so much data in
that’s out there we have so much data in medicine today unbelievable amounts of
medicine today unbelievable amounts of
medicine today unbelievable amounts of data we have data on individuals data on
data we have data on individuals data on
data we have data on individuals data on patients data on physicians we have data
patients data on physicians we have data
patients data on physicians we have data on the quantity quality and composition
on the quantity quality and composition
on the quantity quality and composition of the care we’re delivering or the lack
of the care we’re delivering or the lack
of the care we’re delivering or the lack of quality in the care that we’re
of quality in the care that we’re
of quality in the care that we’re delivering we have data on performance
delivering we have data on performance
delivering we have data on performance of physicians and nurses we have Dan on
of physicians and nurses we have Dan on
of physicians and nurses we have Dan on the price of medical devices and
the price of medical devices and
the price of medical devices and pharmaceuticals we’re entering an era of
pharmaceuticals we’re entering an era of
pharmaceuticals we’re entering an era of big data in biomedicine some of the
big data in biomedicine some of the
big data in biomedicine some of the biggest data actually comes from the
biggest data actually comes from the
biggest data actually comes from the health systems and the physicians and
health systems and the physicians and
health systems and the physicians and the data they generate with you
the data they generate with you
the data they generate with you for example molecular data we’re getting
for example molecular data we’re getting
for example molecular data we’re getting more and more measurements of molecules
more and more measurements of molecules
more and more measurements of molecules where the proteins or DNA from you or
where the proteins or DNA from you or
where the proteins or DNA from you or your tissues or your tumors someday on
your tissues or your tumors someday on
your tissues or your tumors someday on the left is the Whitehead Institute a
the left is the Whitehead Institute a
the left is the Whitehead Institute a picture of the Whitehead Institute one
picture of the Whitehead Institute one
picture of the Whitehead Institute one of the centers that generated a good
of the centers that generated a good
of the centers that generated a good chunk of the genome project that ended
chunk of the genome project that ended
chunk of the genome project that ended in 2003 after 13 years and 3 billion
in 2003 after 13 years and 3 billion
in 2003 after 13 years and 3 billion dollars of effort and on the right is my
dollars of effort and on the right is my
dollars of effort and on the right is my hand holding a USB stick sequencer one
hand holding a USB stick sequencer one
hand holding a USB stick sequencer one of these actually works on the space
of these actually works on the space
of these actually works on the space station now it’s a no-brainer
station now it’s a no-brainer
station now it’s a no-brainer we’re gonna be getting more molecular
we’re gonna be getting more molecular
we’re gonna be getting more molecular data from patients in the future
data from patients in the future
data from patients in the future there’s imaging data whether it’s x-rays
there’s imaging data whether it’s x-rays
there’s imaging data whether it’s x-rays of chests or lungs or bones or CT scans
of chests or lungs or bones or CT scans
of chests or lungs or bones or CT scans or MRIs these are enormous files ranging
or MRIs these are enormous files ranging
or MRIs these are enormous files ranging from 3 megabytes to 3 gigabytes
from 3 megabytes to 3 gigabytes
from 3 megabytes to 3 gigabytes depending on the type of study that your
depending on the type of study that your
depending on the type of study that your physician might order and then there’s
physician might order and then there’s
physician might order and then there’s claims data
claims data
claims data what’s a claim a claim is how we and
what’s a claim a claim is how we and
what’s a claim a claim is how we and medicine send a bill to get paid here’s
medicine send a bill to get paid here’s
medicine send a bill to get paid here’s an example of a handwritten claim you
an example of a handwritten claim you
an example of a handwritten claim you can find on the Internet
can find on the Internet
can find on the Internet they’re electronic now of course that’s
they’re electronic now of course that’s
they’re electronic now of course that’s a top you see some information about a
a top you see some information about a
a top you see some information about a patient their address their age and then
patient their address their age and then
patient their address their age and then you see codes at the bottom codes on
you see codes at the bottom codes on
you see codes at the bottom codes on what do we do with these patients and
what do we do with these patients and
what do we do with these patients and what disorders or conditions we think
what disorders or conditions we think
what disorders or conditions we think the patient has these are how we and
the patient has these are how we and
the patient has these are how we and medicine get paid when we see a patient
medicine get paid when we see a patient
medicine get paid when we see a patient a claims can go only so far
a claims can go only so far
a claims can go only so far to represent a patient even though these
to represent a patient even though these
to represent a patient even though these are electronic and we’ve had them for
are electronic and we’ve had them for
are electronic and we’ve had them for decades you can already see how limiting
decades you can already see how limiting
decades you can already see how limiting they can be the ultimate data to have
they can be the ultimate data to have
they can be the ultimate data to have are your medical records let me give you
are your medical records let me give you
are your medical records let me give you an analogy of the difference between
an analogy of the difference between
an analogy of the difference between claims and medical records let’s say I
claims and medical records let’s say I
claims and medical records let’s say I told you that I really loved going to
told you that I really loved going to
told you that I really loved going to this restaurant called bricks up in Napa
this restaurant called bricks up in Napa
this restaurant called bricks up in Napa Valley maybe some of you have been there
Valley maybe some of you have been there
Valley maybe some of you have been there and you’re curious why do I love this
and you’re curious why do I love this
and you’re curious why do I love this restaurant so much does it really help
restaurant so much does it really help
restaurant so much does it really help you to look at the bill you can see I
you to look at the bill you can see I
you to look at the bill you can see I spend a decent amount of money there
spend a decent amount of money there
spend a decent amount of money there maybe I had a nice party there but
maybe I had a nice party there but
maybe I had a nice party there but wouldn’t you rather see what we ordered
wouldn’t you rather see what we ordered
wouldn’t you rather see what we ordered at the restaurant you can see we ordered
at the restaurant you can see we ordered
at the restaurant you can see we ordered the crab cakes you can see we ordered a
the crab cakes you can see we ordered a
the crab cakes you can see we ordered a Balducci Pinot Noir which of these would
Balducci Pinot Noir which of these would
Balducci Pinot Noir which of these would you rather have to actually understand
you rather have to actually understand
you rather have to actually understand what are we doing what was our
what are we doing what was our
what are we doing what was our experience at the restaurant and that’s
experience at the restaurant and that’s
experience at the restaurant and that’s the difference between medical claims
the difference between medical claims
the difference between medical claims and medical records medical records are
and medical records medical records are
and medical records medical records are the ultimate record what actually is
the ultimate record what actually is
the ultimate record what actually is happening to a patient what exactly is a
happening to a patient what exactly is a
happening to a patient what exactly is a medical record we’re asked to think
medical record we’re asked to think
medical record we’re asked to think about these all the time
about these all the time
about these all the time when we sign forms what is in a medical
when we sign forms what is in a medical
when we sign forms what is in a medical record
record
record well medical records go back to 1907
well medical records go back to 1907
well medical records go back to 1907 they were invented at the Mayo Clinic so
they were invented at the Mayo Clinic so
they were invented at the Mayo Clinic so it’s been a hundred and ten years since
it’s been a hundred and ten years since
it’s been a hundred and ten years since we’ve had paper-based medical records
we’ve had paper-based medical records
we’ve had paper-based medical records and when we think of medical records we
and when we think of medical records we
and when we think of medical records we think of shelves like these you remember
think of shelves like these you remember
think of shelves like these you remember seeing these maybe when you were growing
seeing these maybe when you were growing
seeing these maybe when you were growing up
up
up these are paper-based records in an
these are paper-based records in an
these are paper-based records in an outpatient clinic nicely organized with
outpatient clinic nicely organized with
outpatient clinic nicely organized with stickers and handwritten notes inside
stickers and handwritten notes inside
stickers and handwritten notes inside but these are for outpatients the minute
but these are for outpatients the minute
but these are for outpatients the minute you actually come into a hospital your
you actually come into a hospital your
you actually come into a hospital your medical record grows they become
medical record grows they become
medical record grows they become enormous and they’re stored in binders
enormous and they’re stored in binders
enormous and they’re stored in binders like these and these binders were
like these and these binders were
like these and these binders were strictly defined they’d start with the
strictly defined they’d start with the
strictly defined they’d start with the medication orders than the admit note
medication orders than the admit note
medication orders than the admit note and the progress notes flawed followed
and the progress notes flawed followed
and the progress notes flawed followed by the flow sheets and the nursing notes
by the flow sheets and the nursing notes
by the flow sheets and the nursing notes and then the lab test results and
and then the lab test results and
and then the lab test results and radiology and pathology and then
radiology and pathology and then
radiology and pathology and then somewhere in the back were the social
somewhere in the back were the social
somewhere in the back were the social work notes it’s almost like we had a
work notes it’s almost like we had a
work notes it’s almost like we had a pecking order in medicine
pecking order in medicine
pecking order in medicine physically implemented through the
physically implemented through the
physically implemented through the medical wreck
medical wreck
medical wreck you can only put your notes in the right
you can only put your notes in the right
you can only put your notes in the right place now of course today these are all
place now of course today these are all
place now of course today these are all electronic but back then these were
electronic but back then these were
electronic but back then these were enormous records in the newborn
enormous records in the newborn
enormous records in the newborn intensive care units we used to
intensive care units we used to
intensive care units we used to celebrate when our tiny baby patients
celebrate when our tiny baby patients
celebrate when our tiny baby patients probably weighed more than their medical
probably weighed more than their medical
probably weighed more than their medical records but now of course they’re
records but now of course they’re
records but now of course they’re electronic and the only way electrons
electronic and the only way electrons
electronic and the only way electrons the way electrons but they cost billions
the way electrons but they cost billions
the way electrons but they cost billions of dollars you’re three examples Sutter
of dollars you’re three examples Sutter
of dollars you’re three examples Sutter spent 1 billion dollars on their
spent 1 billion dollars on their
spent 1 billion dollars on their electronic health record system partners
electronic health record system partners
electronic health record system partners over in Boston spent 1.2 billion dollars
over in Boston spent 1.2 billion dollars
over in Boston spent 1.2 billion dollars and Kaiser spent 4 billion dollars on
and Kaiser spent 4 billion dollars on
and Kaiser spent 4 billion dollars on their electronic health records just a
their electronic health records just a
their electronic health records just a tad bit more than the $0.99
tad bit more than the $0.99
tad bit more than the $0.99 you’re questioning whether to purchase
you’re questioning whether to purchase
you’re questioning whether to purchase in the App Store for an app now it’s
in the App Store for an app now it’s
in the App Store for an app now it’s kind of funny if you look at these
kind of funny if you look at these
kind of funny if you look at these headlines the billion dollars Sutter
headlines the billion dollars Sutter
headlines the billion dollars Sutter spent is written up as a boondoggle but
spent is written up as a boondoggle but
spent is written up as a boondoggle but the four billion dollars Kaiser spent is
the four billion dollars Kaiser spent is
the four billion dollars Kaiser spent is written up as winning a bet and they
written up as winning a bet and they
written up as winning a bet and they bought the same software the pays to
bought the same software the pays to
bought the same software the pays to have the right friends as reporters and
have the right friends as reporters and
have the right friends as reporters and these electronic record systems are
these electronic record systems are
these electronic record systems are costing us billions now instead of the
costing us billions now instead of the
costing us billions now instead of the sections of the record we now have
sections of the record we now have
sections of the record we now have tables up to 18,000 tables making up the
tables up to 18,000 tables making up the
tables up to 18,000 tables making up the databases that feed the electronic
databases that feed the electronic
databases that feed the electronic health record systems we have tables
health record systems we have tables
health record systems we have tables that record every encounter in patient
that record every encounter in patient
that record every encounter in patient now patient every drug ordered and
now patient every drug ordered and
now patient every drug ordered and dispensed IV vital sign every lab test
dispensed IV vital sign every lab test
dispensed IV vital sign every lab test result and of course the notes all of
result and of course the notes all of
result and of course the notes all of those millions and millions of text
those millions and millions of text
those millions and millions of text notes every admission note every
notes every admission note every
notes every admission note every progress note every discharge note every
progress note every discharge note every
progress note every discharge note every phone call gets documented in all of
phone call gets documented in all of
phone call gets documented in all of these notes enormous amounts of data yet
these notes enormous amounts of data yet
these notes enormous amounts of data yet despite all of this data we’re still
despite all of this data we’re still
despite all of this data we’re still sometimes missing the most obviously
sometimes missing the most obviously
sometimes missing the most obviously relevant pieces of data let me give you
relevant pieces of data let me give you
relevant pieces of data let me give you an example if a big city hospital sends
an example if a big city hospital sends
an example if a big city hospital sends you home after having major surgery to
you home after having major surgery to
you home after having major surgery to get care by your regular primary care
get care by your regular primary care
get care by your regular primary care doctor
doctor
doctor the big city hospital might never
the big city hospital might never
the big city hospital might never actually know what happened to you after
actually know what happened to you after
actually know what happened to you after that surgery that’s called your outcome
that surgery that’s called your outcome
that surgery that’s called your outcome your outcomes the only raw form of
your outcomes the only raw form of
your outcomes the only raw form of outcomes the big city hospital might
outcomes the big city hospital might
outcomes the big city hospital might have is called your discharge
have is called your discharge
have is called your discharge disposition
disposition
disposition you know what discharge disposition is
you know what discharge disposition is
you know what discharge disposition is did you die or did you leave and if you
did you die or did you leave and if you
did you die or did you leave and if you left did you go home did you go to a
left did you go home did you go to a
left did you go home did you go to a hospice or did you go to another
hospice or did you go to another
hospice or did you go to another hospital discharge disposition is like
hospital discharge disposition is like
hospital discharge disposition is like that other Oak Ridge Boys song you don’t
that other Oak Ridge Boys song you don’t
that other Oak Ridge Boys song you don’t have to go home but you can’t stay here
have to go home but you can’t stay here
have to go home but you can’t stay here so imagine the very next thing that
so imagine the very next thing that
so imagine the very next thing that happens to you whether you did better or
happens to you whether you did better or
happens to you whether you did better or worse is stuck in someone else’s major
worse is stuck in someone else’s major
worse is stuck in someone else’s major computer system let’s think about how
computer system let’s think about how
computer system let’s think about how ridiculous that is for a moment let’s
ridiculous that is for a moment let’s
ridiculous that is for a moment let’s imagine you’re learning how to play a
imagine you’re learning how to play a
imagine you’re learning how to play a game called chess or teach a computer
game called chess or teach a computer
game called chess or teach a computer how to play chess wouldn’t you think the
how to play chess wouldn’t you think the
how to play chess wouldn’t you think the computer will want to know which moves
computer will want to know which moves
computer will want to know which moves it made that led to a winning game or a
it made that led to a winning game or a
it made that led to a winning game or a losing game now imagine trying to learn
losing game now imagine trying to learn
losing game now imagine trying to learn how to play chess and you only get the
how to play chess and you only get the
how to play chess and you only get the first half of the game or imagine trying
first half of the game or imagine trying
first half of the game or imagine trying to learn to play chess and you want to
to learn to play chess and you want to
to learn to play chess and you want to get the last half of the game isn’t it
get the last half of the game isn’t it
get the last half of the game isn’t it obvious
obvious
obvious how limiting that is if these systems
how limiting that is if these systems
how limiting that is if these systems can’t talk to each other we got to do
can’t talk to each other we got to do
can’t talk to each other we got to do better than this
better than this
better than this we got to create new methods and more
we got to create new methods and more
we got to create new methods and more poorly new business models to get health
poorly new business models to get health
poorly new business models to get health systems to start to share this data with
systems to start to share this data with
systems to start to share this data with each other we’re doing this in the
each other we’re doing this in the
each other we’re doing this in the University of California but more
University of California but more
University of California but more importantly we need to figure out how to
importantly we need to figure out how to
importantly we need to figure out how to get this data from you because you know
get this data from you because you know
get this data from you because you know if you’re doing better beyond your
if you’re doing better beyond your
if you’re doing better beyond your surveys of whether you like to are care
surveys of whether you like to are care
surveys of whether you like to are care or like the parking structure at our
or like the parking structure at our
or like the parking structure at our facilities are you actually doing better
facilities are you actually doing better
facilities are you actually doing better we need to do better than this
we need to do better than this
we need to do better than this and we can do better than this we got to
and we can do better than this we got to
and we can do better than this we got to actually build these systems and
actually build these systems and
actually build these systems and actually start to tap into ways that you
actually start to tap into ways that you
actually start to tap into ways that you can electronically communicate with us
can electronically communicate with us
can electronically communicate with us to give us the data we need now we have
to give us the data we need now we have
to give us the data we need now we have all this data and we spent billions to
all this data and we spent billions to
all this data and we spent billions to acquire it but how are we going to get
acquire it but how are we going to get
acquire it but how are we going to get this to the scientists and analysts and
this to the scientists and analysts and
this to the scientists and analysts and software engineers who know what to do
software engineers who know what to do
software engineers who know what to do with this data
with this data
with this data in a safe respectful way it’s your
in a safe respectful way it’s your
in a safe respectful way it’s your medical record data we have to
medical record data we have to
medical record data we have to de-identify that data and to me it’s
de-identify that data and to me it’s
de-identify that data and to me it’s really important for me to teach you
really important for me to teach you
really important for me to teach you what does it mean to de-identify a
what does it mean to de-identify a
what does it mean to de-identify a medical record data the identification
medical record data the identification
medical record data the identification is not something we can make up it’s
is not something we can make up it’s
is not something we can make up it’s coded in federal law appears in an
coded in federal law appears in an
coded in federal law appears in an example of the federal law we have to
example of the federal law we have to
example of the federal law we have to remove 18 different types of identifiers
remove 18 different types of identifiers
remove 18 different types of identifiers from that medical record that make us
from that medical record that make us
from that medical record that make us know it belongs to you for example at
know it belongs to you for example at
know it belongs to you for example at the top it’s obvious we got to remove
the top it’s obvious we got to remove
the top it’s obvious we got to remove your name from the record we got to
your name from the record we got to
your name from the record we got to remove the dates that we saw you and so
remove the dates that we saw you and so
remove the dates that we saw you and so much more
much more
much more and we tell you we’re doing these things
and we tell you we’re doing these things
and we tell you we’re doing these things and then after we’ve de-identified these
and then after we’ve de-identified these
and then after we’ve de-identified these records and certified they’re
records and certified they’re
records and certified they’re de-identified then we can get this to
de-identified then we can get this to
de-identified then we can get this to the software engineers and analysts and
the software engineers and analysts and
the software engineers and analysts and the scientists to figure out what’s
the scientists to figure out what’s
the scientists to figure out what’s working in medicine and what might be
working in medicine and what might be
working in medicine and what might be excessive in medicine and when we
excessive in medicine and when we
excessive in medicine and when we combine that clinical data in molecular
combine that clinical data in molecular
combine that clinical data in molecular data and wearable data and behavioral
data and wearable data and behavioral
data and wearable data and behavioral data and your preferences when we
data and your preferences when we
data and your preferences when we combine all that maybe then we can
combine all that maybe then we can
combine all that maybe then we can customize the health care we deliver to
customize the health care we deliver to
customize the health care we deliver to you and that is what we call precision
you and that is what we call precision
you and that is what we call precision medicine the customization of healthcare
medicine the customization of healthcare
medicine the customization of healthcare we can deliver to you based on all of
we can deliver to you based on all of
we can deliver to you based on all of that data and not just from you but from
that data and not just from you but from
that data and not just from you but from the entire population with the outcomes
the entire population with the outcomes
the entire population with the outcomes to learn what is working and not working
to learn what is working and not working
to learn what is working and not working in medicine and apply it to you now to
in medicine and apply it to you now to
in medicine and apply it to you now to get there we’re going to need to build
get there we’re going to need to build
get there we’re going to need to build an enormous database we’re gonna need a
an enormous database we’re gonna need a
an enormous database we’re gonna need a lot of people sharing their data in a
lot of people sharing their data in a
lot of people sharing their data in a safe de-identified way and a molecular
safe de-identified way and a molecular
safe de-identified way and a molecular data and the clinical data and the
data and the clinical data and the
data and the clinical data and the imaging data and then give that to
imaging data and then give that to
imaging data and then give that to scientists and how are we gonna get
scientists and how are we gonna get
scientists and how are we gonna get there well one way forward is through
there well one way forward is through
there well one way forward is through the precision medicine initiative and
the precision medicine initiative and
the precision medicine initiative and now called all of us research cohort
now called all of us research cohort
now called all of us research cohort this is the goal that President Obama
this is the goal that President Obama
this is the goal that President Obama set out years ago to recruit a million
set out years ago to recruit a million
set out years ago to recruit a million or more volunteers maybe some of you to
or more volunteers maybe some of you to
or more volunteers maybe some of you to contribute to medical record data and
contribute to medical record data and
contribute to medical record data and your molecular data and blood tests and
your molecular data and blood tests and
your molecular data and blood tests and D identify that so we can learn what
D identify that so we can learn what
D identify that so we can learn what keeps healthy people healthy and what
keeps healthy people healthy and what
keeps healthy people healthy and what can we do to customize to care for those
can we do to customize to care for those
can we do to customize to care for those that are ill we have a long way to go to
that are ill we have a long way to go to
that are ill we have a long way to go to build this but you’re going to start to
build this but you’re going to start to
build this but you’re going to start to see health systems and physicians asking
see health systems and physicians asking
see health systems and physicians asking you to start to participate in research
you to start to participate in research
you to start to participate in research studies like this I do hope you start
studies like this I do hope you start
studies like this I do hope you start to say yes what am I trying to do for
to say yes what am I trying to do for
to say yes what am I trying to do for precision medicine in the University of
precision medicine in the University of
precision medicine in the University of California I’m trying to build maps maps
California I’m trying to build maps maps
California I’m trying to build maps maps of death and disease now compare that to
of death and disease now compare that to
of death and disease now compare that to Google Maps which takes you to pleasant
Google Maps which takes you to pleasant
Google Maps which takes you to pleasant destinations I’m trying to figure out
destinations I’m trying to figure out
destinations I’m trying to figure out how Californians get diseases and die in
how Californians get diseases and die in
how Californians get diseases and die in our state right here’s an example of a
our state right here’s an example of a
our state right here’s an example of a map made by Hannah and J Hannah was a
map made by Hannah and J Hannah was a
map made by Hannah and J Hannah was a researcher in my lab she runs her own
researcher in my lab she runs her own
researcher in my lab she runs her own research group now in Korea and Jay
research group now in Korea and Jay
research group now in Korea and Jay helped us with the visualizations here’s
helped us with the visualizations here’s
helped us with the visualizations here’s an example of a map with real California
an example of a map with real California
an example of a map with real California data on the top left circle that means
data on the top left circle that means
data on the top left circle that means that we see patients showing up with
that we see patients showing up with
that we see patients showing up with alcoholism and then if you got to the
alcoholism and then if you got to the
alcoholism and then if you got to the bottom right a year later we see these
bottom right a year later we see these
bottom right a year later we see these same patients showing up with liver
same patients showing up with liver
same patients showing up with liver disease or liver cirrhosis and then if
disease or liver cirrhosis and then if
disease or liver cirrhosis and then if you zip back to the left there they’re
you zip back to the left there they’re
you zip back to the left there they’re showing up a liver abscesses and you can
showing up a liver abscesses and you can
showing up a liver abscesses and you can do this zigzag or you could come
do this zigzag or you could come
do this zigzag or you could come straight down the squares mean the
straight down the squares mean the
straight down the squares mean the patients died of those two diseases so
patients died of those two diseases so
patients died of those two diseases so it’s really rare to die of alcoholism
it’s really rare to die of alcoholism
it’s really rare to die of alcoholism you typically die of those other two
you typically die of those other two
you typically die of those other two disorders the maps can get very
disorders the maps can get very
disorders the maps can get very complicated here on the Left patients
complicated here on the Left patients
complicated here on the Left patients show up at acute myocardial infarction
show up at acute myocardial infarction
show up at acute myocardial infarction that’s a heart attack you can die right
that’s a heart attack you can die right
that’s a heart attack you can die right away of that but if you take the
away of that but if you take the
away of that but if you take the northern route you end up next in a year
northern route you end up next in a year
northern route you end up next in a year with heart failure that means the heart
with heart failure that means the heart
with heart failure that means the heart muscle isn’t strong enough to pump the
muscle isn’t strong enough to pump the
muscle isn’t strong enough to pump the blood it needs and you can die of that
blood it needs and you can die of that
blood it needs and you can die of that or that leads to lung disease the orange
or that leads to lung disease the orange
or that leads to lung disease the orange circle and the fluid starts to back up
circle and the fluid starts to back up
circle and the fluid starts to back up because the heart can’t pump that blood
because the heart can’t pump that blood
because the heart can’t pump that blood fast enough and the big blue circle on
fast enough and the big blue circle on
fast enough and the big blue circle on the right is sepsis septicemia that’s a
the right is sepsis septicemia that’s a
the right is sepsis septicemia that’s a blood infection now I’m a pediatrician I
blood infection now I’m a pediatrician I
blood infection now I’m a pediatrician I never really saw many patients showing
never really saw many patients showing
never really saw many patients showing up but a heart attack but I always
up but a heart attack but I always
up but a heart attack but I always thought that if you had a heart attack
thought that if you had a heart attack
thought that if you had a heart attack it’s the heart that does does you in in
it’s the heart that does does you in in
it’s the heart that does does you in in the end but it’s actually an infection
the end but it’s actually an infection
the end but it’s actually an infection that does he win at the end after three
that does he win at the end after three
that does he win at the end after three years and if you don’t take the northern
years and if you don’t take the northern
years and if you don’t take the northern route you can take the southern route
route you can take the southern route
route you can take the southern route and you kill your kidneys first and then
and you kill your kidneys first and then
and you kill your kidneys first and then end up with sepsis that way now what I’m
end up with sepsis that way now what I’m
end up with sepsis that way now what I’m trying to do is to build these maps now
trying to do is to build these maps now
trying to do is to build these maps now I love Google Maps I use Google Maps all
I love Google Maps I use Google Maps all
I love Google Maps I use Google Maps all the time but they’re still one thing
the time but they’re still one thing
the time but they’re still one thing Google Maps can’t do Google Maps can’t
Google Maps can’t do Google Maps can’t
Google Maps can’t do Google Maps can’t show you where all the cars are on the
show you where all the cars are on the
show you where all the cars are on the map I know it shows you the traffic
map I know it shows you the traffic
map I know it shows you the traffic but it doesn’t show you each and every
but it doesn’t show you each and every
but it doesn’t show you each and every little car on the map how could it ever
little car on the map how could it ever
little car on the map how could it ever do that right but for me my vision for
do that right but for me my vision for
do that right but for me my vision for the University of California isn’t just
the University of California isn’t just
the University of California isn’t just to build the maps and show the maps I
to build the maps and show the maps I
to build the maps and show the maps I actually want to see what all of our 15
actually want to see what all of our 15
actually want to see what all of our 15 million patients are doing on the map
million patients are doing on the map
million patients are doing on the map where are they where are they going next
where are they where are they going next
where are they where are they going next this is a prototype with real California
this is a prototype with real California
this is a prototype with real California data you can see as patients are getting
data you can see as patients are getting
data you can see as patients are getting older we’re making the colors brighter
older we’re making the colors brighter
older we’re making the colors brighter the age is going up at the top right a
the age is going up at the top right a
the age is going up at the top right a lot of them are trying to get diseases
lot of them are trying to get diseases
lot of them are trying to get diseases and dye a whole bunch of that I’m gonna
and dye a whole bunch of that I’m gonna
and dye a whole bunch of that I’m gonna hit that sepsis purple circle in a
hit that sepsis purple circle in a
hit that sepsis purple circle in a moment then they’re gonna die there they
moment then they’re gonna die there they
moment then they’re gonna die there they go and we can start to use this map
go and we can start to use this map
go and we can start to use this map right we can start to predict what’s
right we can start to predict what’s
right we can start to predict what’s gonna happen next what’s gonna happen in
gonna happen next what’s gonna happen in
gonna happen next what’s gonna happen in the next 90 days what’s gonna happen in
the next 90 days what’s gonna happen in
the next 90 days what’s gonna happen in the next year and what are we gonna do
the next year and what are we gonna do
the next year and what are we gonna do about it
about it
about it and that to me is going to be the new
and that to me is going to be the new
and that to me is going to be the new definition for precision medicine how
definition for precision medicine how
definition for precision medicine how can we actually use all that molecular
can we actually use all that molecular
can we actually use all that molecular clinical behavior preference data to
clinical behavior preference data to
clinical behavior preference data to accurately and accountably deliver
accurately and accountably deliver
accurately and accountably deliver precision care to our 15 million
precision care to our 15 million
precision care to our 15 million patients in University California and
patients in University California and
patients in University California and that’s what we’re trying to build this
that’s what we’re trying to build this
that’s what we’re trying to build this is the future so we’re surrounded by
is the future so we’re surrounded by
is the future so we’re surrounded by data and medicine but data doesn’t do
data and medicine but data doesn’t do
data and medicine but data doesn’t do anything by itself it’s stuck it’s
anything by itself it’s stuck it’s
anything by itself it’s stuck it’s frozen in these ponds and puddles there
frozen in these ponds and puddles there
frozen in these ponds and puddles there you’re puddles to go splashing in those
you’re puddles to go splashing in those
you’re puddles to go splashing in those puddles learn what’s in your medical
puddles learn what’s in your medical
puddles learn what’s in your medical record data and start to share your
record data and start to share your
record data and start to share your medical record data with scientists and
medical record data with scientists and
medical record data with scientists and researchers in these large research
researchers in these large research
researchers in these large research cohorts we need everyone’s help to build
cohorts we need everyone’s help to build
cohorts we need everyone’s help to build this new future a precision medicine
this new future a precision medicine
this new future a precision medicine thank you
thank you
thank you you
”
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